NICE urges greater use of novel anticoagulants

New guidance from the National Institute for Health and Care Excellence (NICE) says that around 7,000 strokes and 2,000 premature deaths could be prevented each year through effective detection of atrial fibrillation (AF) and protection with anticoagulant drugs.

AF increases the risk of stroke by up to five times and is estimated to cause around 12,500 strokes a year, but only half of the people who should be receiving anticoagulant treatment are getting it, says Professor Mark Baker, NICE’s director of clinical practice.

‘This needs to change if we are to reduce the numbers of people with AF who die needlessly or suffer life-changing disability as a result of avoidable strokes,” he added.

Until recently, the only anticoagulant available to people with AF who were assessed as being at increased risk of stroke was warfarin which, while and effective, has drawbacks, including interactions with food and other medicines and the requirement for regular monitoring and dose adjustments. But since 2012, NICE has approved a number of novel oral anticoagulants (NOACs), and it says these are not only “potential lifesavers for some people with AF,” but also an option for those newly diagnosed with AF who have a higher risk of stroke and for those currently taking aspirin for stroke prevention.

However, there is evidence that NOACs are not being as widely prescribed as they could, and the first consensus statement to be published by the NICE Implementation Collaborative (NIC), coinciding with the new guidance, highlights the steps needed to increase their use.

The guideline also makes a strong recommendation that aspirin should not be offered to people with AF solely on account of increased risk of stroke; new evidence shows that aspirin is not as effective as anticoagulants in these groups, and that it is not as safe in terms of causing bleeding.

Also accompanying the new guidance and the NIC report is NICE’s first pilot Patient Decision Aid, which includes a tool for patients to rate what is and isn’t important to them in stroke prevention.

Patient groups have been missing out, said NIC member the Association of the British Pharmaceutical Industry (ABPI), which welcomed the release of the consensus statement as “timely.”

Chief executive Stephen Whitehead applauded the statement’s call for NOACs to be automatically included in local formularies without further adaption of guidance at a local-organisation level, and called for an urgent review of local arrangements, alongside the development of policies so that NOACs can be better implemented into local care pathways.

And Helen Williams, consultant pharmacist and Royal Pharmaceutical Society (RPS) spokesperson, said the new guidance will be “key to saving lives.”